Provider Demographics
NPI:1174762991
Name:HUMERA SIDDIQUI, O.D., P.A.
Entity type:Organization
Organization Name:HUMERA SIDDIQUI, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMERA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-870-2405
Mailing Address - Street 1:904 CYPRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3456
Mailing Address - Country:US
Mailing Address - Phone:407-870-2405
Mailing Address - Fax:407-870-2409
Practice Address - Street 1:904 CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3456
Practice Address - Country:US
Practice Address - Phone:407-870-2405
Practice Address - Fax:407-870-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty